Background: Anxiety is one the main problems of patients on waiting list for endoscopic procedures. Previous studies have indicated adverse effects of anxiety on these patients. Aim: to determine the effect of sound therapy on the anxiety and blood pressure of patients on waiting list for endoscopy. Methods: This was a randomized clinical trial, in which 124 patients on waiting list for endoscopy were randomly divided into control and experimental groups at the department of endoscopy in Mustafa Khomeini hospital in 2012- 2013. Patients in the experimental group received nature-based sounds 20 minutes before endoscopy, while the control group received routine interventions. Anxiety (using spielburger questionnaire) and blood pressure were measured 20 minutes and immediately before endoscopy in both groups. The data were analyzed by independent t-test, chi-square, and Fisher’s exact tests using SPSS (v. 14). Results: In the experimental group, 56.45% were women and in the control group 54.84% were men. The mean score of anxiety in the experimental and control groups was 31.6±3.3 and 68.9 ±9.5, respectively after the intervention (p<0.05). The mean systolic blood pressure of the experimental and control groups after the intervention was 120.6 ±11.5 and 150.0 ±20.8, respectively (P<0.001). Conclusion: Sound therapy had positive effects on reducing the anxiety of patients on the waiting list for endoscopy and may reduce BP and anxiety. Thus, it is recommended as a non-pharmacologic intervention.

Background: Feeding intolerance is a major concern in preterm infants. Appropriate position during feeding is one of the interventions that nurses can exploite in order to improve the feeding tolerance in preterm infants. Aim: Comparison of the effect of nutrition in the kangaroo mother care and supine position on gavage residual volume in preterm infants. Methods: Thisrandomized single-blind clinical trial was conducted on 100 preterm infants in 2012. The infants in the first group were feeded twice in kangaroo mother care position and then twice in supine position.The infant of second group were feeded vise versa. The gastric residuals were measured 1 and 2 hours after each feeding and compared with each other. The researcher-made questionnair was used for data entry. Data analysis was done with chi-square, Fisher, Maan Whitney, T-Tests, and mixed models using SPSS11.5. Results: The two groups were similar regarding weight, gestational and calendar age, and the amount of milk. In group I, the mean weight was 1558.3±202.7 , gestational age 30.2±4.6 and quantity of milk 20.8±6.0 while these were 1547.5±168.8, 30.6±1.8 and 20.8±5.5 was in group II, respectively. The average gastric residual volume two hours after feeding in kangaroo mother care position (0.9±1.6) was lower than that in supine position (2.0±2.3) (p<0/001). Conclusion: The findings suggest that feeding preterm infants in the kangaroo mother care position reduces the gastric residual volume, therefore, nurses can feed preterm infants in this position to improve nutritional tolerance.

Background: establishing a regular respiratory condition in the infants is one of the basic considerations in NICU. Newborns show noticeable breath alterations in response to even low concentrations of some fragrance. Aim: determining the effect of breast milk odor on oxygen saturation and respiratory rate in premature infants. Methods: In this four-group randomized clinical trial, 180 premature infants were divided into three control groups and one experimental group of 45 neonates in each. Three groups received odors (breast milk, formula, distilled water odor) for 120 seconds twice daily for 7 days. Oxygensaturation was recorded before and after the exposure and respiratory rate was documented of 120 seconds stimulation, in the second 60-second of the stimulation. The research instrument was a questionnaire designed by the researcher and completed daily. Data were analyzed by repeated measure and Kruscul Wallis tests using SPSS software version 11.5. Results: The infants were85 (47%) boys and 95 (53%) girsl with mean gestational age of 32.1± 3.1 weeks. Repeated measures analysis demonstrated that aromatherapy with breast milk odor alters SpO2 (p< 0.04) and decreases the time needed for O2 therapy (p< 0.04). Comparing the mean respiratory rate of the understudied infants, there was a difference between the control groups with three others (p< 0.005). Conclusion: exposure with the breast milk odor is a proper and simple nursing care which can reduce the need for O2 therapy trough its effect on O2 saturation and respiration in premature infants.

Background: The elderly have less physical activity due to laziness, having no partners, lack of interest and motivation in life. Exhilarating physical activities can increase number of meetings between elderly, their amusement, and increase tendency to do exercise, which eventually results in the improvement in their balance and fear of falling. Aim: To compare the effect of exhilarating and normal physical activity on the balance and fear of falling in the elderly residing in nursing homes. Methods: In this two-group clinical trial, 63 elderly residents in nursing homes of Mashhad were studied. The intervention group did exhilarating physical activities for 20 minutes 3 times a week for 2 months while the control group did routine exercises of the nursing home. The research tools were Berg and fear of falling tests. Data were analyzed by independent-t and Mann-Whitney tests using SPSS 11.5 Software. Results: The mean age of the elderly was 72.5 ± 7.0 years. The mean balance scores for post-intervention were 38.3 ± 12.0 in the intervention and 29.4 ± 6.1 in control groups (P<0.001). Analysis of covariance showed that the elimination of the variable of fear of falling in elderly before the intervention, the average correction for fear of falling was significantly different between the two groups: control (51.7 ± 31.2) and intervention (41.5 ± 22.4) (P<0.001). Conclusion: Fun physical activities are deterrent of balance and fall disorders. Therefore, with informing the authorities of nursing homes of the exhilarating physical activities protocol and performing it, the onset of several motor deficits and balance can be prevented.

Background: Particular circumstances in the intensive care unit have led the patients to experience significant levels of pain and discomfort. On the other hand, these patients cannot express their discomfort due to several reasons. Aim: to develop the causes of discomfort in the intensive care units. Methods: In order for assessing the causes of discomfort, the initial questionnaire was extracted with 60 items and its content validity was then confirmed by experts. Questionnaires were completed for 220 patients hospitalized in intensive care units of Imam Reza and Ghaem hospitals of Mashhad, in 1392. The exploratory factor analysis was used to determine the discomfort factors. The reliability coefficient of the questionnaire was applied by Cronbach’s alpha and approved by inter-raters agreement. Data analysis was performed with SPSS version 14. Results: Factorial analysis showed that the components of the 30-item questionnaire of discomfortfactors in the intensive care units was identified in 5 domains including: isolation and loneliness (7 questions), anxiety (6 factors), the ICU environment (6 factors), treatment (6 factors), and pathophysiologic factors (5 factors). The range of Cronbach’s alpha coefficient for sub-scales of the questionnaire of discomfort factors in the intensive care unit was between 0.65 and 0.85, and cronbach’s alpha coefficient for the whole tool was 0.86. Conclusion: the questionnaire of discomfort factors is designed to assist the nursing staff of the intensive care units to identify discomfort factors in patients and ultimately improve the quality of care for them. The psychometric characteristics of this questionnaire confirm its validity and reliability, so that it can be used to determine the source of discomfort among the ICU patients.

Background: Different physical and mental complications in patients with stroke, and the chronic nature of the disease, require the presence of their family as the primary source of constant care and support at home. However, for many reasons, such as not receiving adequate support from the medical staff, families face many failures in managing the care programs. Aim: to investigate the effects of family empowerment program on adherence to treatment regimens in stroke patients. Methods: This was a randomized controlled trial with post-test-only design conducted in two hospitals of Tehran university of medical sciences in 1391-92, on stroke patients and their main care-givers in two groups of experimental (N= 30) and control (N= 30). For the experimental group, family empowerment program including assessment, education, and referral follow-up was carried out, while the control group received the routine care. Data were collected using the researcher-made Adherence to the Treatment Regimen Questionnaire. Data were analized using SPSS version 11.5 and the statistical tests of Fisher’s exact test, Chi-square and independent t-tests. Results: The mean age of patients in the intervention group was 70.6 ± 7.7 years, and in the control group 68.8 ± 1.0 years. The independent t-test showed a significant difference in the scores of adherence to treatment in all three fields between the two groups (p<0.001). Conclusion: Due to the effectiveness of family empowering program, and by introducing this method to healthcare system, family empowerment can play an important role in the adherence of patients with stroke to treatment regimens.

Background: Hormonal changes in pregnancy can alter a person's emotions and feelings. The most common mental disorders during pregnancy are anxiety and depression. Relaxation is one of the interventions that increases comfort through affecting the sympathetic system, and can probably reduce psychological tension in pregnant women. Aim: To investigate the effect of progressive muscle relaxation on depression, anxiety and stress of primigravid women. Methods: This randomized clinical trial was conducted on 66 primigravid women from April to September 1393(2014) in two health care centers covered by health center No-1 in the city of Mashhad. Subjects were randomly divided into two groups of progressive muscle relaxation and control. After two sessions of relaxation within two weeks, the intervention group was doing exercises at home for 4 weeks. The instrument used in this study, was Depression Anxiety Stress Scale (DASS 21). Data were analyzed with SPSS statistical software version 11.5, using descriptive statistics and Mann-Whitney U and independent t-tests. Results: The mean age of subjects in this study was 25.5±4.3 years. Before the study, the two groups showed no significant differences in depression (p=0.24), anxiety (p=0.36) and stress (p=0.58); but after the intervention, depression (p=0.001), anxiety (p<0.001) and stress (p<0.001) of the pregnant women was significantly lower in the progressive muscle relaxation group than those of the control group. Conclusion: Due to the relaxation effect on reducing depression, anxiety and stress, and also lack of side effects and its easy applicability, this method can be recommended to use as an approach to reduce depression, anxiety and stress in women during pregnancy.

Background: There are extremely stressful stimuli in NICU environment. Although attempts have already saved neonates in this unit, this can disturb the adaptability of the infants in with environmental stimuli. Aim: To determine the effect of quiet time protocol implementation on physiological characteristics of preterm infants. Methods: In this cross-sectional clinical trial, 120 premature infants were randomly divided into experimental and control groups in Neonatal Intensive Care Unit of Ghaem Hospital, Mashhad in year 1393. The quiet time protocol, including preparing the environment, adjustment of the nursing staff and mothers, was performed in the intervention group between 16:00-18:00 p.m., and the control group received routine programs at 11:00-13:00 hours. Blood pressure, heart rate, and respiratory rate were measured in 15-min intervals during the intervention, and one hour before and after both times, as well as the sound level and light intensity. Data analysis was done by Independent t-test, Mann Whitney, ANOVA with Repeated Measures, and Friedman tests using SPSS version 11.5. Results: Of all infants, 40% were girls and 60 % boys. There was no significant difference between the groups regarding systolic (p<0.44) and diastolic BP (p<0.36). The mean heart rate of the intervention group at the second hour of intervention (135.7±12.4) was significantly lower than the control group (145.7±14.4) (p<0.02). Respiratory rate at the second hour of the intervention was lower in the quiet time group than that in control (p<0.007). Conclusion: The implementation of quiet time protocol can decrease heart rate and respiratory rate through decrease in the environmental stimuli (noise, light and handling), and is recommended for reducing stress in preterm infants.